HomeMy WebLinkAboutCancel request form7&0L\ EVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted ,prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
- CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
C nt actor.
ANCELLATION OF PERAUT — The cancellation of a permit is acceptable only if no work has been done.
ancellatlo f permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
Site Address:
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation
Permit Number: 0"10` 0
State License SLC License
License SLC License
The undersigned does h eby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fe�or damages sing from any and all claims of action for any reason, which may arise as a result of this change of
contrac r/subco11trac r or ellation of permit. A permit cannot be cancelled if vyork has been performed.
OF,OVPER (or
NAME
State of Florida, County of St. Lucie County
The following instrum nt was acknowledged before me this
day of ID Q 20 1)_0 by
�, 1'ti O I7/Y{h�b is personally known to me
or who has DFoduced as D.
Signature of N Pa. C E N VAM G H N
State of Florida -Notary Publi
+= Commission # GG 27CommisioEx
0079
- MY October 22n2022res
Revised 04/1
SIGNATURE GE7kAL CONTRACTOR (or new GC, as applicable)'
1911101
State of F1 'da, County of St. Lucie County
The foll ing instrument was acknowledged before me this
day of 20_, by
who is personally known to
or who has produced as 1D.
Signature of Notary Date